Fewer stroke patients attend hospital on time, but those who do receive immediate medical attention.

There has been an alarming decline in the number of stroke patients getting to hospital on time for effective stroke treatment highlighting the importance of  stroke awareness campaigns.

According to the Irish National Audit of Stroke National Report: A critical review of national stroke data for Ireland from 2013 to 2021 by the National Office of Clinical Audit (NOCA), the proportion of stroke patients who arrived at hospital within three hours of the onset of their stroke symptoms decreased from 59 per cent in 2013 to 46 per cent on 2021.

A stroke is a medical emergency which requires urgent treatment.  The sooner a person arrives to hospital is assessed by a doctor, and receives a brain scan, the less damage is likely to happen.  This results in better outcomes and less disability.

The report was launched by Professor Joe Harbison, Clinical Lead on the Irish National Audit of Stroke (INAS), at a NOCA conference today (31 January 2023).

Professor Harbison said, “Our analysis of data from nine years has shown slow but significant areas of improvement in many areas and improved organisation and delivery of care in hospitals even through the challenges of the pandemic. It’s clear, however, that challenges still exist, and key performance indications such as being admitted to a stroke unit, or having swallow assessed on admission, are still not being achieved in too many cases. The analysis has also shown the importance of reinforcing public education about recognizing the symptoms of stroke as delays to presentation to hospital are gradually increasing and ‘time is brain”.

In order to raise awareness of the signs of stroke and the importance of calling an ambulance as soon as possible, the Irish Heart Foundation launched a new F.A.S.T. stroke campaign yesterday (30^th Jan).

The NOCA report also found that 73 per cent of patients got to hospital within the crucial 4.5-hour window for effective stroke treatment in 2014; however, this figure had dramatically reduced to just 58 per cent in 2021.

The good news from the NOCA report is that once a stroke patient arrives at hospital, the processes involved in accessing timely treatment with thrombolysis and thrombectomy “have improved considerably” over the reporting period (2013-2021).

According to the data, the proportion of patients with a stroke who were seen by a medical team within 10 minutes of arrival at the hospital has more than doubled between 2016 and 2021, from 23 per cent to 48 per cent, suggesting that stroke patients can be assured of immediate attention on arriving at the Emergency Department.

The report also found that the proportion of patients who had brain scan within 1 hour of arrival at hospital increased from 20 per cent in 2013 to 48  per cent in 2021.

The NOCA report analysed data on 34, 630 patients with stroke admitted to hospital between 2013 and 2021. Over the 9 years, there has been a 23 per cent increase in stroke admissions, with a reduction in the proportion of patients aged 80 years and older and an increase in patients aged 64 years and younger. There has been a 29 per cent reduction in mortality for ischaemic stroke.

The report also found that the IV thrombolysis (administration of clot-busting drugs to treat stroke) rate decreased from 11 per cent in 2013 to 10 per cent in 2021.  This could be increased if people arrived in hospital as soon as possible.

However, for those who were treated with thrombolysis, the proportion who received it within 60 minutes of arrival at hospital increased considerably, from 25 per cent in 2013 to 56 per cent in 2021.

The number of patients who received thrombectomy increased from 157 in 2016 to 422 in 2021. Between 2016 and 2021, the overall rate of thrombectomy was 8.4 per cent. In Europe, the current thrombectomy rate is just 1.9 per cent.

Commenting, Chris Macey, Director of Advocacy with the Irish Heart Foundation, said, “The latest audit figures provide further evidence of the shocking decline in numbers getting into hospital after stroke in time to give themselves the best chance of recovery.

“The average stroke destroys two million brain cells every minute. Acting fast can be the difference between walking out of hospital after a few days or spending the rest of your life being unable to walk or talk and being dependent on others.

“Emergency stroke services have improved out of all recognition in recent years – treatments like thrombectomy and thrombolysis and the development of stroke units in our hospitals have saved huge numbers of lives. But none of this matters if you don’t get to hospital on time. Every day human tragedies are playing out around the country, completely avoidably, because people don’t realise how much even a few minutes matter.”

To raise awareness of the signs of stroke and the importance of calling an ambulance as soon as possible, the Irish Heart Foundation launched a new F.A.S.T. stroke campaign yesterday (30^th Jan).

Effective stroke treatment is hugely time-dependent. The faster you act, the more of the person you can save.

For more information on the Irish Heart Foundation’s FAST campaign please see here.

You can view the full NOCA report here and the summary report here